Data Management and Analysis Centre, Discipline of Public Health, University of Adelaide, South Australia.
Aust N Z J Public Health. 2010 Dec;34(6):589-93. doi: 10.1111/j.1753-6405.2010.00613.x. Epub 2010 Oct 7.
Antipsychotics are commonly used in the elderly despite limited efficacy and safety data from randomised controlled trials. Observational comparative safety studies of antipsychotics vary, which may be due to confounding.
To compare the characteristics of typical and atypical antipsychotic initiators.
Using the Australian Government Department of Veterans' Affairs claims dataset, we compared patient and prescribing physician characteristics and health care utilisation between atypical and typical antipsychotic initiators. Significant independent predictors of use were calculated using a multivariate log-binomial model.
Compared to patients initiated on typical antipsychotics (n=10,966), patients initiated on atypical antipsychotics (n=9,239) were less likely to be male (Relative Risk (RR)=0.91, 95% CI 0.89-0.94) and have prior dispensing of morphine (RR=0.53, 95% CI 0.49-0.57) and oral corticosteroids (RR=0.86, 95% CI 0.81-0.91) and to have been hospitalised for myocardial infarction or pneumonia. Patients initiated on atypical antipsychotics were more likely to be in aged care (RR=1.08, 95% CI 1.05-1.12), to be prescribed the medicine by their usual doctor (RR=1.12, 95% CI 1.09-1.16) and have prior dispensing of anticholinesterases (RR=1.19, 95% CI 1.15-1.23), antidepressants (RR=1.18 95% CI 1.15-1.22) and anti-parkinson medications (RR=1.30, 95% CI 1.25-1.36).
Differences between typical and atypical antipsychotic initiators indicate the potential for confounding in observational studies. Future pharmacoepidemiogical research in Australia, investigating the adverse events of antipsychotics, should consider the variables identified in this study to control for confounding.
尽管随机对照试验提供的疗效和安全性数据有限，抗精神病药仍在老年人中广泛应用。抗精神病药的观察性比较安全性研究结果各异，这可能是由于混杂因素所致。
比较典型和非典型抗精神病药起始者的特征。
利用澳大利亚退伍事务部索赔数据集，我们比较了起始用典型和非典型抗精神病药患者的患者和处方医生特征以及医疗保健利用情况。使用多变量对数二项式模型计算使用的显著独立预测因素。
与起始用典型抗精神病药的患者（n=10966）相比，起始用非典型抗精神病药的患者（n=9239）更可能为女性（相对风险（RR）=0.91，95%CI 0.89-0.94），且更不可能曾配用吗啡（RR=0.53，95%CI 0.49-0.57）和口服皮质类固醇（RR=0.86，95%CI 0.81-0.91），且更不可能因心肌梗死或肺炎住院。起始用非典型抗精神病药的患者更可能在老年护理机构（RR=1.08，95%CI 1.05-1.12），更可能由其常规医生处方该药物（RR=1.12，95%CI 1.09-1.16），且更可能曾配用抗胆堿酯酶药（RR=1.19，95%CI 1.15-1.23）、抗抑郁药（RR=1.18 95% CI 1.15-1.22）和抗帕金森药物（RR=1.30，95% CI 1.25-1.36）。
典型和非典型抗精神病药起始者之间的差异表明，观察性研究中存在混杂的可能性。未来在澳大利亚进行的抗精神病药不良事件的药物流行病学研究，应考虑本研究中确定的变量，以控制混杂因素。
